HomeMy Public PortalAbout5200 CAMELLIA AVE_Plumbing__ 76A667 DOS 17 7-51 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES LU ' N it 1
WILLIAM J. FOX-., CHIEF ENGINEER
(STRICT NO. GRO P ZONE ILt<MIT NU.
FOR APPLICANT TO FILL IN
PLUMBC�R - RECEIVED BY READY FOR DATE IB UED
FIRST INSPECTION
ADDRESS
"
Ss._.
BUILDING
CITY TEL No. ADDRESS --•j) _
COUNTY LOCALITY
LIC SE N0. EXPIRES
NEAREST
PERMIT FEESCR°5
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
_vy WATER CLOSET(TOILET) 0 0.50 $ ADDRESS
BATH TUB 0.50 CITY TEL. No.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
OAS SYSTEM OUTLETS @ 0.50
SIGNATURE 1w
WATER HEATER @ 0.50 PERMITTIE --
BLOP 5 1 N K c 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.30
DRINKING FOUNTAIN 13.30
URINAL @ 0.50 -1
Q
HOUSE SEWER @ O.BO Z
MISCELLANEOUB C7
a
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
PAS PIPING
GAS VENT
CESSPOOL a 1,00 CESSPOOL
SEPTIC TANKC SEPTIC TANK
DRAIN ( ) PIT ( ) a 1.00 SEWER
PERMIT I 1.00 GAS TEST
UTILITY CO.NOTIFIED S 1'•�L
TOTAL FEE
77
I �_
FINAL
I hereby that IMhavega certificate teLofconslent�tosalf aIE:711-.o) APPLICATION FOR PLUMBING PERMIT
� or a certificate of Workers'Compensation Insurance,or
i c�rtifled copy thereof(Sec. 3900,Lab.C.) "fl
COUNTY OF LOS ANGE S BUILDING AND SAFETY
Policy No. Company
Certified copy Is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
Ab DR ESS i
Certified copy is ailed with the county budding inspection NUMBER FIXTURE OR rem • FEE
department. WATER CLOSET LOCALITY 4
Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' 1
COMPENSATION INSURANCE SHOWER OWNER /L7
(Thi section need not be �mplEted If the wog} fIIrot�Od LAVATORY AADRE88
by the permit is for orte handled dollars ($100) or leo.) SINK /,l 8
CITY TEL.NO �ist�e�
1 certify that in the performance of the work for which this
-permit Y issued, I&hall not employ any person IRany manner DISHWASHER CONTRACTOR O
to as to become subject to the Worker' Compensation Laws. CLOTHES WASHER, ADDRESS
NOTICE TO APPLICANTSWIMMING POOL RECEPTOR LL
: If, after making tbls Certificate of
CITY TEL.NO.
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code, you must forth- LICENSE NO. ASS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. OAS 13YBTEM OUTLETS DISTRICT NO. 10 RO D BY
LICENSED CONTRACTORS DECLARATION OUTLETS•OVER
I hereby affirm that I am licensed under provisions of Chapter B PER SYSTEM
9 (commencing with Section 7000) of Dtvbdon 3 of the Bush FINAL N
ness and Professions Code, and my license Is in full force and DATE — (o — $ f
effect.
FINAL
License Number J Lic.Class r r
Contractor Date
DI am exempt from the Licensing requirements as I am a Plan check fee
licensed architect or a registered professiogal engineer PLUMBING PERMIT ISSUING FEE j
acting In pay professional capacity (Section '1051, Bur
iness and Professions Code). TOTAL FEF
Lic.or Rek.No. Date Plan check appllasnt
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section.7031.5, Bwl 101ty Tel.No,
neer and Professions Code):
o I, of the pre si
excluvely contracting
with ors to cons"ct the project
( w Professions Code).
CONSTRUCTION LEND GENCY
I hereby affirm that there is ■ conrtru lending agency #'0'0'0 0 o 5
for the performance of the work for which this pe1-mlt is
issued (Sac. 3097.Civ.C.). 2 1 6 5 0
Lender's Name
Lender's Address 0,0 0 1 E1 5 0 iS
I certify that I have read thfs application and state that the .01105—8 1
above information L correct.I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE
au o representatives of this County to enter upon aha
• entioned propert�r inspect n purposes. t
Signature of Permittee Date